Associate Consultant, Zero Balance (PRN)

Role & Responsibilities:

• Manage client projects and relationships by participating in meetings, managing action items through to completion, answering client questions, and independently writing client emails

• Compile, QA, and independently manage client processes from start to finish, such as provider relation escalations, bulk issues, regular reports, and invoices

• Manage internal staffing and project needs, including answering questions from other team members on assigned client and monitoring project profitability

• Research and determine next steps for complex and new payer issues and reimbursement areas to uncover potential opportunities, such as reimbursement guidelines and healthcare legislation

• Create and update project plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data

• Review and summarize pricing documents based on hospital contracts to calculate expected payments, including Medicaid, percentage of charge, per diems, Medicare IPPS, MSDRG, outlier and/or stoploss, implants, drugs, and other reimbursement models

• Make thorough client observations and recommendations after completing a project audit regarding underpayment exposure, contract risk, and other potential issues

• Work with other account executives and managers to effectively submit bulk listings of accounts to insurance companies for reprocessing (e.g. rebill)

• Escalate accounts to insurance provider relations for resolution and payment, including corresponding appropriately with provider relations teams, tracking progress of issues and ensuring that deadlines are met

• Examine feedback from other internal teams on project activity and provide teams appropriate direction regarding account action when auditing and/or pursuing payments

• Contribute meeting content to team meetings, AC biweekly meetings, and internal project related meetings

• Help create and implement process improvements and trainings to protect future revenue

• Understands and implements best practices for internal processes, communication, and documentation

• Other duties as assigned

• Schedule: 6-10 Hours Weekly

Skills & Experience

• A minimum of 3 years of experience in areas of research and analysis

• A minimum of 3 years of verifiable work history

• A minimum of 3 years of experience with managed care contracts and hospital reimbursement

• A minimum of 2 years of experience working with clients or equivalent

• Must have achieved High School Diploma or GED

• 3 years of experience working in MS Office, with emphasis on advanced Excels skills, requiring experience with formulas, graphing, and reports to manipulate pricing tools and edit project reports

• Demonstrated problem solving and critical thinking skills

• Demonstrated ability to meet project deadlines

• Demonstrated excellent written and verbal communication skills, to include writing professional documents and delivering presentations.

• Diligent and strong attention to detail

Preferred Skills:

• Access: Update and link queries and tables, create steps to calculate reimbursement

• Understanding the basics of MySQL (specifically: modification in a field or table- following field and data requirements)